Balas Michele, Buckingham Rose, Braley Tami, Saldi Sarah, Vasilevskis Eduard E
University of Nebraska Medical Center, College of Nursing, Department of Community Based Health, Omaha, NE 68198, USA.
J Gerontol Nurs. 2013 Aug;39(8):39-51. doi: 10.3928/00989134-20130530-06. Epub 2013 Jun 10.
A recently proposed interprofessional, evidence-based, multicomponent approach to mitigating the effects of intensive care unit (ICU)-acquired delirium and weakness has the potential to radically transform the way care is delivered to older adults requiring sedation, mechanical ventilation, or both. The Awakening and Breathing Coordination, Delirium Monitoring and Management, and Early Mobility (ABCDE) bundle empowers members of the interdisciplinary ICU team to implement the best available evidence regarding mechanical ventilation, sedation, weakness, and delirium in a safe, effective, and patient-centered manner. Considering that critically ill older adults are cared for in a number of different settings during the course of hospitalization and recovery, the purpose of this article is to explore the rationale and possible benefits of extending the ABCDE bundle into the post-ICU setting. We provide a case study that illustrates how ABCDE bundle adoption could be the key to improving the quality of care provided to seriously ill older adults in the ICU and beyond.
最近提出的一种跨专业、基于证据的多组件方法,用于减轻重症监护病房(ICU)获得性谵妄和虚弱的影响,有可能从根本上改变为需要镇静、机械通气或两者兼有的老年人提供护理的方式。觉醒与呼吸协调、谵妄监测与管理以及早期活动(ABCDE)集束化治疗使跨学科ICU团队成员能够以安全、有效且以患者为中心的方式,实施关于机械通气、镇静、虚弱和谵妄的最佳现有证据。鉴于重症老年患者在住院和康复过程中会在多种不同环境中接受护理,本文旨在探讨将ABCDE集束化治疗扩展到ICU后环境的基本原理和可能的益处。我们提供了一个案例研究,说明了采用ABCDE集束化治疗如何可能成为提高ICU及其他地方重症老年患者护理质量的关键。